1. Some Aspects Of Regional Blood Circulation Stimulation By Indirect Revascularization In Patients With Critical Limb Ischemia On The Background Of Distal Steno-Occlusion Of Arteries

Authors

  • J.V. Kosaev Scientific Center of Surgery named after M.A. Topchubashev, Baku, Azerbaijan
  • N.S. Abushov Scientific Center of Surgery named after M.A. Topchubashev, Baku, Azerbaijan
  • I.L. Namazov Scientific Center of Surgery named after M.A. Topchubashev, Baku, Azerbaijan
  • N.I. Babaev Scientific Center of Surgery named after M.A. Topchubashev, Baku, Azerbaijan

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Abstract

Objective: To study the peculiarities of regional blood circulation stimulation by indirect revascularization in patients with critical limb ischemia (CLI) on the background of distal steno-occlusion of arteries.

Materials and methods: study was carried out in 210 patients with CLI on the background of distal steno-occlusion of arteries. 48 patients conducted standard treatment (control group). Regional blood flow was stimu-lated in 42 patients with a standard operation of revascularizing osteotrepanation (ROT) (group I), in 51 patients with lumbar sympathectomy (LSE) (group II), in 38 patients - LSE + ROT (group III), in 31 patients - modified with intraosseous laser irradiation (ROT with IOLI) (IV group). The following indicators of arterial and venous blood flow were determined: rheographiy index (RI), linear blood flow velocity (LBV) in the popliteal artery, standing and lying, regional systolic pressure (RSP) standing and lying, regional systolic pressure gradient (RSPG), post-occlusal ve-nous pressure (POVP) standing and lying, the gradient of post-occlusal venous pressure (GPOVD), venous arterial flow index (VAFI) standing and lying. Oxygen saturation of skin (OSS) in the distal part of the foot was also studied. The parameters of regional arterial and venous blood circulation were compared with identical parameters of 48 practically healthy individuals (“reference group”).

Results: upon admission to the clinic, patients revealed a sharp violation of the arterial and venous parts of the regional macro- and microhemodynamics. Indirect methods of revascularization, in comparison with the initial data, reliably mobilize regional blood circulation, reduce the degree of chronic ischemia, which is accompanied by an increase in the number of patients with significant and moderate improvement in clinical status. Statistical analysis showed that the mobilization of arterial and venous blood flow reliably depends on the method of stimula-tion (p <0.05 -0.001). In the I and II group of patients, a weak correlation was revealed (r = 0.3), and in the III and IV group of patients, a moderate correlation was found (r = 0.5-0.6). Leveling of RI, LBV and OSS parameters reliably (p <0.05-0.001) depends on the method of blood circulation stimulation with weak (r = 0.3) correlation in group I patients and moderate (r = 0.4-0.6) correlation in II, III, IV groups of patients. These positive results were most pronounced in patients who underwent ROT surgery with IOLI.

Conclusion: stimulation of peripheral blood flow by indirect methods of revascularization is reasonable (p <0.05-0.001 with r = 0.3-0.4-0.5-0.6), if shunt operations in patients with CLI on the background of distal steno-occlusion of arteries is not possible to perform, allowing you to maintain the supporting function of the limb and improve the quality of life.

Keywords

distal artery occlusion, critical lower limb ischemia, stimulation of regional hemodynamics, indirect revascularization

References

  1. Stimulation of the regional blood flow of pa-tients with CLI on the background of distal steno-occlusion of arteries is significantly (p <0.05 - 0.001) dependent on indirect revas-cularization methods with weak (r = 0.3) or moderate (r = 0.4-0, 6) correlation
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Published

2020-07-01

Issue

No. 2 (2020)

Section

Статьи